5.29 pm

Dr. Evan Harris (Oxford, West and Abingdon):
I agree with much of what the hon. Member for Banbury (Tony Baldry) said about the state of the NHS in

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Oxfordshire, but I do not believe that the Bill would add to any inspection regimes that might exist to measure sensible outcomes. Indeed, it appears to focus on measures that are not sensible. I put it to the House that it is no good measuring silly things better. Mechanisms already exist for measuring the sensible thingshealth outcomesthat need to be measured.

It must be understood that the Government strategy for escaping responsibility for poor performance in the national health service is to shift the blame. They are doing that, first, through continuous structural change, to appear to be busy while making matters worse. Secondly, they insist on creating changes in working patterns, labelled "modernisation", which does not appear to have any influence on improved patient care, then criticise people who oppose that change because it is change for change's sake. The third prong of their strategy is to name and shame, which they do through league tables.

The creation of yet another inspectorate on top of those that already exist gives more weight to the idea that the problem of investment, staffing and morale is not the Government's failure, but a failure of some hospitals involving poor management or poor clinical care, and plays into the Government's hands. Current problems, including waiting lists, waiting times and clinical cleanliness, which appear in the motion moved by the hon. Gentleman, are not sensible measures of outcomes. Many of the outcome targets that the Government measured for their league tables were wholly dependent on trusts' ability to staff their hospitals, which involves the availability of clinical staff, as the hon. Gentleman said, the level of Government resources and, of course, trusts' ability to fiddle the figures.

Creating another inspectorate to measure how much the figures are fiddled does not do anything to improve patient care. Indeed, yet another inspectorate will simply play the Government's game of scapegoating. Waiting lists are merely a measure of activity; the more operations that are available on the health service, the greater the number of people waiting. The critical factor is average waiting time, not how many people are waiting. The continuing focus on waiting list numbers has distorted clinical priorities and has often led to people waiting longer. Rigid Government waiting-time targets create distortions themselves, as people are brought in to meet the 18-month, 15-month and 12-monthapparently soon to be six-monthlimit at the expense of critically ill people who should be treated within 18 days or 18 hours. That is happening at the John Radcliffe and many other hospitals. Focusing on such measures through the proposed inspectorate or other inspectorates does not help.

Another flaw in the proposal is the suggestion that an inspectorate can sensibly measure hospital efficiency without taking effectiveness into account. Hospitals can be hugely efficient when they are 100 per cent. full, but they are not effective if they cannot admit anyone. If, by clinical cleanliness the hon. Gentleman means cross-infection rates, those should already be being measured by good clinical practiceclinical audit and clinical governance. If the Government focused on sensible outcome measures, I would be more prepared to welcome the measures that they have introduced through, for example, the Commission for Health Improvement, the continuing work of the Audit Commission, clinical governance and clinical audit, which ensure that those measures are accurately presented and publicised.

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The Government have an incentive, not to look at real outcomes, which are getting worse, but to create league tables. If we ever focus on sensible outcome measures, mechanisms for assessing them already exist. To a certain extent, the quality agenda has been met by those measures; clinical revalidation of doctors and, I hope, other health professionals is assessed in a way that yet another inspectorate will not match. If anything, morale in hospitals is suffering because clinical staff, who are working hard, face a profusion of inspections. At the John Radcliffe, morale is already at rock bottom from the Government's scapegoating and the naming and shaming exercise of league tables; that is without the threat of yet another inspection, which will simply show that the hospital does not have the resources or staff.

I was delighted that the hon. Gentleman called for more nurses, beds and funding, as we have not heard that from his party before. However, we also need no more inspectorates and no more false measures.

I urge hon. Members to reject the Bill. Although we currently measure the wrong things badly, it will not help to measure the wrong things better.

Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.

Hospital Inspectorate

Tony Baldry accordingly presented a Bill to establish an independent inspectorate of hospitals to provide independent inspection of waiting lists, waiting times, hospital efficiency and clinical cleanliness: And the same was read the First time; and ordered to be read a Second time on Friday 23 November, and to be printed [Bill 45].

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Orders of the Day

International Development Bill [Lords]

Order for Second Reading read.

5.36 pm

The Secretary of State for International Development (Clare Short):
I beg to move, That the Bill be now read a Second time.

The purpose of the Bill is legislatively to entrench poverty reduction as the overriding aim of United Kingdom development assistance and to ensure that with two exceptions, which I shall come to, money for development assistance is spent for that reason alone.

As hon. Members know, the reduction of poverty has been the guiding principle of all our development efforts since 1997. That central objective and the clarity of focus that it brings have been widely supported in debates on the Bill in the House and in the other place, and by the International Development Committee and the public.

Under existing legislation, the Secretary of State could change that policy without reference to Parliament. She has an undesirable amount of flexibility in using development assistance resources, and a future Secretary of State could, for instance, reinstate a policy of tying aid, thus distorting its use and decreasing its efficiency, or use the aid budget to pursue other short-term political or commercial ends.

Clearly, any future Government have the right to change policy, but given the growth in our budget and in parliamentary and public support for our poverty reduction focus, I believe that any future Government should be required to seek Parliament's approval for a shift away from poverty reduction as our central policy objective.

We should continually remind ourselves that one in five of the 6 billion people who share the planet still live in abject poverty. With the abundance and knowledge that exist in the world, it shames and disgraces us that such poverty and inequality continue. Although that is perhaps the most important moral issue of our time, it is also a practical issue which engages our interests. If, in our increasingly globalised world, we fail to deal with such division and inequality, we can expect even more instability and environmental degradation, which will endanger our future and that of subsequent generations.

Since 1997, the United Kingdom has led the international effort to place the systematic reduction of poverty at the core of the whole international development effort. We have not only focused our bilateral programme on poverty reduction, but worked throughout the international system to achieve a global commitment to focus it on the systematic reduction of poverty in every developing country.

There has been much progress. All the main players in the international development community, including the World Bank, most multilateral development banks, the Organisation for Economic Co-operation and Development, the United Nations, the International Monetary Fund and the G7, have agreed that the international development targets, which are now incorporated in the millennium development goals, should

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be the central objective of the collaborative international development effort. Those goals were reaffirmed at the UN's millennium assembly.

We firmly believe that an international development system dedicated to those goals can greatly improve current performance and that the targets are achievable if we focus our efforts and improve our effectiveness. I do not know whether the hon. Member for Banbury (Tony Baldry) has received my letter, but the world is already on track to meet the goal of halving the proportion of people living in extreme poverty between 1990 and 2015. That will enable 1 billion people to lift themselves out of extreme poverty.

The World Bank projects that, on present trends, the proportion of the population of developing countries living on less than $1 a dayI should stress that that is less than the equivalent of what a dollar a day buys in the US; in other words, it is a tiny incomewill fall to 12.3 per cent. in 2015, compared with 29 per cent. in 1990. That will be a considerable achievement, but it depends on a continuing commitment to reform focused on poverty reduction led by the developing countries themselves and supported by the international community, and we must be clear that it will still leave millions in abject poverty.